Current rheumatology reports
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Trigger points (TrP) are hyperirritable spots in a taut band of a skeletal muscle, which usually have referred pain. There is controversy over whether TrP are a peripheral or central nervous system phenomenon. Referred pain, the most characteristic sign of TrP, is a central phenomenon initiated and activated by peripheral sensitization, whereby the peripheral nociceptive input from the muscle can sensitize dorsal horn neurons that were previously silent. ⋯ Several studies support the hypothesis that TrP can induce central sensitization, and appropriate TrP treatment reduces central sensitization. In contrast, preliminary evidence suggests that central sensitization can also promote TrP activity, although further studies are needed. Proper TrP management may prevent and reverse the development of pain propagation in chronic pain conditions, because inactivation of TrP attenuates central sensitization.
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Many people throughout the world have both chronic pain and obesity. Overweight and obese people are more prone to a proinflammatory state manifesting as metabolic syndrome but also to a higher prevalence of chronic pain comorbidities. ⋯ Changes in lifestyle, behavior, physical activity, and diet have demonstrated benefits in functional capacity and QoL; therefore, patient assessment should tackle high BMI and metabolic syndrome as part of the treatment of chronic pain. A healthier lifestyle would lead to a lower inflammatory state and consequently to an improvement in function and QoL in overweight or obese patients who have chronic pain conditions.
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Review
Osteoporosis and orthopedic surgery: effect of bone health on total joint arthroplasty outcome.
Osteoporosis is a common condition. As the population ages, more patients with osteoporosis will require orthopedic procedures, including arthroplasty. Adverse outcomes are more likely for patients with osteoporosis requiring orthopedic procedures, for example those with intraoperative fractures, periprosthetic osteolysis with implant migration, and postoperative periprosthetic fractures. ⋯ Vitamin D deficiency is common among patients undergoing joint arthroplasty and the ideal vitamin D level for joint arthroplasty has yet to be determined. Both bisphosphonates and teriparatide may aide successful osteointegration among patients undergoing noncemented joint arthroplasty. Focusing on bone health perioperatively should result in better outcomes for orthopedic procedures.
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Belimumab has recently been approved, and several other types of biological therapy with different mechanisms of action are currently in phase II and III studies. This review puts these approaches in context, emphasizing mechanistic categories and clinical trial designs. Most of the promising approaches involve B cell depletion or modulation. Post-approval experience with belimumab is critically reviewed.
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Systemic sclerosis (SSc) is a heterogeneous condition characterized by the deposition of excess collagen in skin and internal organs due to vasculopathy, immune activation, low grade inflammation, and fibrosis. Progressive diffuse cutaneous SSc with organ involvement has a poor prognosis. ⋯ The ASTIS and SCOT trials will determine whether the benefits of HSCT outweigh the risks of serious adverse events including treatment-related mortality of around 6-10% and potential long-term complications. Better patient selection and safer transplant regimens may improve the outcome of HSCT for SSc.